Plantar fasciitis is probably the most common cause of pain under the heel. Often a combination of approaches is needed to cure this stubborn injury. Here we explain the symptoms, treatment, and exercises to cure Plantar fasciitis.
Plantar Fasciitis Symptoms
- Pain under the heel which develops gradually over time.
- Often pain may radiate forwards into the arch of the foot.
- There may be tenderness in the sole of the foot and under the heel when pressing in. This can range from being slightly uncomfortable to acutely painful.
- Pain is usually worse first thing in the morning and improves during the day.
Assessment tests
A professional therapist would undertake a full assessment. This may include:
- Case history.
- Physical examination.
- Biomechanical analysis.
- They may use X-rays or other imaging techniques to diagnose plantar fasciitis.
What else might it be?
Other heel injuries can have similar symptoms:
- Bruised heel – bruising of the tissues under the heel. Pain does not normally radiate into the arch and is not worse first thing in the morning.
- Heel spur – is a tiny bone growth at the point where the plantar fascia attaches to the heel and can occur at the same times as Plantar fasciitis.
- Calcaneal stress fracture – is a stress fracture of the heel bone. Pain does not normally radiate into the arch.
Below we outline some common differences between plantar fasciitis and bruised heel.
What is Plantar fasciitis?
The Plantar Fascia (or plantar aponeurosis) is a broad, thick band of tissue which runs from under the heel bone (calcaneus), to the front of the foot. Its function is to provide support to the foot when standing and shock absorption when running. Inflammation or degeneration of the tendon where the fascia originates at the heel causes pain.
Plantar fasciitis or Plantar fasciopathy?
The term Plantar fasciitis refers to inflammation (‘itis’ means inflammation). Traditionally people thought inflammation was the issue. However, studies have shown actual inflammatory cells are not present in most cases. Therefore, degeneration of the tissues is thought to be a more likely cause. Hence the term Plantar fasciopathy is more appropriate.
What causes Plantar fasciitis?
Overuse is thought to be the main cause of plantar fasciitis. It is more common in sports which involve running, dancing or jumping. However, there are a number of factors which can increase your chances of developing Plantar fasciitis heel pain:
Foot Biomechanics
Overpronation is where the foot rolls in or flattens too much when running or walking. As the foot flattens, it stretches the plantar fascia more than normal, therefore increasing the strain on the tissues.
A foot which has a high arch is known as pes cavus. This foot type is often rigid and therefore unable to absorb shock and impact forces. Therefore, the strain on the plantar fascia is increased.
Footwear
Wearing inappropriate footwear such as very flat and unsupporting shoes can increase the likelihood of developing plantar fasciitis. If you are a runner then choosing the correct running shoes for your foot type is essential. If you overpronated then a motion control shoe is best. Oversupinators often have a high arch and a neutral shoe with cushioning is usually advised.
Bodyweight
Overweight individuals or those who do a lot of heaving lifting at the workplace increased loads on the foot. Therefore, increasing the chances of developing heel pain.
Flexibility
If you have tight calf muscles or plantar fascia then you are at a higher risk of developing plantar fasciitis. Or, if you have tight hamstrings or gluteal muscles then this also increases your risk because of the effect they have on foot biomechanics.
Plantar Fasciitis Treatment
Treatment consists of reducing pain and inflammation, stretching the plantar fascia and lower leg muscles and identifying potential causes. Heel pain can be very stubborn to treat and often a combination of approaches is best in treating plantar fasciitis.
Cold therapy
Apply the PRICE principles of protection, rest, ice, compression and elevation to relieve pain and inflammation. Do not apply ice directly to the skin as it may cause ice burns. Wrap ice in a wet tea towel or use a commercially available gel pack.
Apply ice or cold therapy for up to 10 minutes every hour whilst it is particularly painful. Reduce this to 3 times a day as symptoms improve and additionally after exercise.
Plantar fasciitis taping
Taping is an excellent way of instantly relieving symptoms. It works by supporting the arch of the foot and reducing the strain on the plantar fascia.
This, therefore, allows the tissues to heal. You may need to apply tape regularly until symptoms resolve but many people notice an immediate improvement.
How to tape for Plantar fasciitis
Plantar Fasciitis Exercises
Exercises to stretch the plantar fascia and the calf muscles are an important part of treatment and recovery. Resting alone may reduce pain and inflammation but if part of the cause is tension in fascia then the injury is likely to recur.
Plantar Fascia Stretch – is done by pulling the foot and toes upwards aiming to feel a stretch in the arch of the foot.
Calf muscle stretches – both with the leg straight and with the bent can be done 3 to 5 times a day.
Foot rolling – rolling the foot over a ball can also help stretch underneath the foot.
Strengthening exercises – as this is an overuse injury, the priority is on rest and stretching. However, in some cases exercises to strengthen the arch can help prevent the injury recurring.
View all Plantar Fasciitis exercises
Footwear
Protect and support the foot by wearing comfortable shoes or trainers. Hard or flat-soled shoes are likely to make symptoms worse. You can wear a cushioning heel pad or insole to help relieve pain. However, if overpronation is an issue then orthotic type insoles will be more appropriate long term.
Plantar fasciitis night splint
A night splint is a very effective way of treating Plantar fasciitis. It prevents the Plantar fascia from tightening up overnight, therefore avoiding tenderness first thing in the morning.
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Massage for Plantar fasciitis
In the later stages, a professional therapist may apply deep tissue massage to help stretch and relax the plantar fascia. Massage helps to stimulate blood flow and loosen tight tissues underneath the foot which cause pain.
For more stubborn injuries a doctor may use a corticosteroid injection. Platelet-rich plasma injections have also been shown to be effective. If symptoms do not resolve then surgery is an option but this is rare.
Electrotherapy
Extracorporeal Shock Wave Therapy – is a method of therapeutic treatment for soft tissue injuries. It works by passing shock waves (short but intense energy waves) which travel faster than the speed of sound, into the tissues.
Ultrasound – transmits high frequency sound waves into the tissues. This has a micro massage effect and can reduce pain and inflammation.
Medication
A doctor may prescribe anti-inflammatory medication such as ibuprofen. This may be effective in the early stages to reduce pain and inflammation. But long term use may actually inhibit healing.
Gait analysis
This involves analysing your feet and how they function when you walk and run. If you overpronate, or your feet flatten then this increases the stress on the plantar fascia. Orthotic inserts may be prescribed to help correct any biomechanical issues of the foot.
More on Overpronation
Plantar fasciitis surgery
Surgery is used in around 5% of people whose symptoms do not improve after a minimum of nine months, even after continuous treatment. However, the success rate is still only estimated at around 70-80%. In most cases now, a procedure called a plantar fascia release is performed.
This releases (cuts) between 30 and 50% of the fascia’s fibers. This helps to reduce the stress on the fascia. Complications can include nerve damage, fallen arches, infection and ongoing symptoms. Recovery after surgery if successful is around 9 to12 weeks before the patient may return to work.
FAQs
Plantar fasciitis is the most common cause of gradual onset heel pain. It is inflammation of the plantar fascia under the arch of the foot. Symptoms include pain under the heel which is worse first thing in the morning. Pain may also radiate into the arch of the foot. Read more on symptoms.
Overuse is thought to be the main cause of plantar fasciitis. It is more common in sports which involve running, dancing or jumping. However, there are a number of factors which can increase your chances of developing Plantar fasciitis including footwear, foot biomechanics, bodyweight and flexibility. Read more on causes.
In the early stages apply cold therapy and rest to reduce pain and inflammation. Plantar fasciitis taping can help reduce the load on the arch of the foot. When pain allows gentle stretching exercises can begin and should be done regularly. Read more on treatment.
Stretching exercises for the plantar fascia and calf muscles are most important. Read more on plantar fasciitis stretches.
References
- Lemont H, Ammirati KM, Ulsen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc 2003;93(3):234-37
- Riddle DL, Pulisic M, Pidcoe P et al. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Br 2003;85-A(5):872-7
- Gonnade N1, Bajpayee A2 et al Regenerative efficacy of therapeutic quality platelet-rich plasma injections versus phonophoresis with kinesiotaping for the treatment of chronic plantar fasciitis: A prospective randomized pilot study. Asian J Transfus Sci. 2018 Jul-Dec;12(2):105-111
- Malahias MA, Cantiller EB, Kadu VV, Müller S. The clinical outcome of endoscopic plantar fascia release: A current concept review. Foot Ankle Surg. 2018 Dec 23. pii: S1268-7731(18)30233-9
